OP0263 INFLAMMATORY RHEUMATIC DISEASES HAVE BROAD IMPACT ON REPRODUCTIVE HEALTH – A NATIONWIDE EVALUATION AND SYSTEMATIC COMPARISON ACROSS RHEUMATIC DISEASES
Authors: N. Mars, A. Kerola, K. Eklund, H. Laivuori, S. Ripatti, A. Palomäki, F. Registry
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Inflammatory rheumatic diseases (IRDs) affect men and women of reproductive age. The lack of reproductive health studies on IRDs hinders making evidence-based recommendations on fertility preservation, prevention of pregnancy complications, and management of the IRDs during reproductive years. <h3>Objectives</h3> To systematically estimate the impact of IRDs on diverse reproductive outcomes and compare the effects to those observed for other immune-mediated inflammatory diseases. <h3>Methods</h3> The total Finnish population (FinRegistry; N=5,339,804) was linked to nationwide registries (inpatient and outpatient care, and Medical Birth Register covering all live births since 1987, N=1,920,411 births). We focused on seropositive and seronegative rheumatoid arthritis (RA), ankylosing spondylitis (AS), juvenile idiopathic arthritis (JIA), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE), and Sjögren syndrome (SS), selecting individuals born 1964–1984 diagnosed with the IRD before age 30, and 20 sex, birth-year, and education level-matched controls. The patterns were compared to a range of other immune-mediated inflammatory diseases, such as type 1 diabetes, inflammatory bowel disease, and hypothyroidism. <h3>Results</h3> The case count of women with an IRD ranged from 412 for PsA to 1,487 for seropositive RA (mean age range at diagnosis 11.0 in JIA to 25.7 in AS). Women with IRD experienced a higher prevalence of childlessness than controls (mean difference 4.2%, largest in JIA at 9.3%), had fewer children (mean 0.2 fewer, highest in JIA at 0.3 fewer), and the start and end of reproduction were slightly shifted towards an earlier age. Also men with an IRD experienced a higher prevalence of childlessness than controls (mean difference 4.1%, largest in SLE at 11.0%). Overall, the impact was similar in other immune-mediated inflammatory diseases in both women and men, with high variability between diseases. For maternal health conditions, five IRDs showed an elevated risk for pre-eclampsia, with the largest effect size observed for SLE (OR 2.65, 95%CI 1.94–3.62). No elevated risk was observed for gestational diabetes in any of the IRDs. Many of the IRDs were associated with at least one of the ten evaluated adverse perinatal outcomes, such risk of nonelective Caesarean section, and admission to neonatal ICU (<b>Figure 1</b>), with the largest effect sizes observed for SLE and SS. <h3>Conclusion</h3> In this comprehensive, nationwide evaluation of reproductive health metrics, we observed widespread impact of IRDs on reproductive health. The effects were comparable to many other immune-mediated inflammatory diseases, but we also observed high variability between diseases. Overall, these findings emphasize the need for further research, and the importance of counseling on reproductive health in both men and women with IRDs. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Nina Mars: None declared, Anne Kerola Speakers bureau: Boehringer-Ingelheim, Sanofi, Consultant of: Advisory boards of Pfizer, Gilead and Boehringer-Ingelheim, Grant/research support from: Congress travel sponsorship from Pfizer and Mylan., Kari Eklund: None declared, Hannele Laivuori: None declared, Samuli Ripatti: None declared, Antti Palomäki Speakers bureau: Boehringer-Ingelheim, Pfizer, Sanofi, Consultant of: Pfizer, AbbVie and Amgen, Fin Registry: None declared.